A. Grech

The relationship between volumetric brain changes and cognitive function: A family study on schizophrenia

BACKGROUND We examined the cerebral correlates of intelligence, memory, and executive processing in 56 patients with schizophrenia or schizoaffective disorder and 90 of their nonpsychotic relatives to establish whether the pattern of structure--function relationships in these two groups was different from that in 55 control subjects. METHODS Magnetic resonance imaging data were acquired, and volumetric measurements were made for whole brain, prefrontal region, lateral ventricles, third ventricle, temporal lobes, hippocampi, and cerebellum. RESULTS In the total sample, full intelligence quotient (IQ) and verbal IQ correlated with the volume of the whole brain and right hippocampus; the latter was also associated with performance IQ. Left hippocampal size was associated with verbal IQ and, in control subjects and nonpsychotic relatives only, with estimated full IQ. Delayed verbal memory was linked to cerebellar and inversely to left hippocampal volume. Discrepancies in the relationship pattern emerged in patients with schizophrenia between left hippocampus and measures of IQ and verbal memory. CONCLUSIONS The latter data indicate a loss of a normal structure--function relationship in schizophrenia and might reflect a functional compensation occurring secondary to early neurodevelopmental impairment.

Hippocampal volume in familial and nonfamilial schizophrenic probands and their unaffected relatives.

BACKGROUND There is evidence for hippocampal volume loss in schizophrenia, but the etiology of this remains unclear. The aim of our study was to assess the contribution of familial liability and obstetric complications to hippocampal volume reduction in schizophrenia. METHODS Hippocampal volumes were obtained using stereological methods from magnetic resonance scans performed on 35 schizophrenic probands from multiply affected families and 63 of their unaffected relatives, as well as 31 schizophrenic probands from families with no other affected members, 33 of their unaffected relatives, and 68 control subjects. RESULTS Probands with schizophrenia, regardless of family history, had significant volume reduction of the left hippocampus. Hippocampal volume was not significantly reduced in either group of relatives. Obstetric complications were associated with left hippocampal volume reduction. CONCLUSIONS We failed to find evidence that hippocampal volume loss is associated with familial liability to schizophrenia but have confirmed the association between hippocampal volume reduction and exposure to obstetric complications.

Normal cerebral asymmetry in familial and non-familial schizophrenic probands and their unaffected relatives

Loss of normal fronto-occipital cerebral asymmetry has been reported in patients with schizophrenia and also in their well relatives from multiply affected families, suggesting a relationship with susceptibility genes. We sought to confirm this relationship in a family study of patients with schizophrenia and their unaffected relatives of presumed differing genetic risk. MRI scans were carried out on 25 probands from families multiply affected with the disorder, and 36 of their unaffected relatives, 34 probands from families with no other affected members, 42 of their unaffected relatives, and 76 controls. Volumetric measurements of prefrontal, premotor, sensorimotor and occipitoparietal regions were obtained from which a measure of fronto-occipital torque was derived. There were no significant differences in measurements of fronto-occipital torque between the subject groups. Both schizophrenic probands and their relatives displayed the normal pattern of cerebral asymmetry, with larger right than left frontal regions and a larger left than right occipitoparietal region. Our findings failed to confirm an association between loss of fronto-occipital torque and genetic liability for schizophrenia and also failed to replicate the previously reported association between loss/reversal of fronto-occipital asymmetry and schizophrenia.

Maternal exposure to influenza and paranoid schizophrenia

Previous research has suggested that schizophrenics exposed to influenza in the second trimester have more delusions of jealousy, delusions of reference and suspiciousness. We therefore hypothesised that the risk-increasing effect of in utero exposure to influenza would be particularly demonstrable in paranoid schizophrenia. We studied patients with an ICD diagnosis of schizophrenia in England and Wales who were born each month between 1923 and 1965 (N = 17,247. Chi-square test for trend showed that an increase in influenza exposure level during the fifth month of gestation was accompanied by an increase in the proportion of patients with paranoid schizophrenia. However, logistic regression analysis including sex, seasonality and birth period in the model resulted in the loss of any significant association between in utero exposure to influenza and the development of paranoid schizophrenia, the loss of this significance being mainly accounted for by birth period. Therefore, the association in utero exposure to influenza and subsequent development of paranoid schizophrenia we hypothesised was not supported by our data.

The Multidisciplinary Approach to Mood Disorders

This article outlines the use of the multidisciplinary approach to mood disorders in the Short Stay Psychiatric Unit (SSPU) in Mater Dei Hospital, Msida, Malta. An audit was carried out on all patients whose first admission to SSPU was in 2008 and who were diagnosed with having a mood disorder. The aim was to see whether the use of a multidisciplinary approach is in actual fact affecting patient outcome or not. The latter was measured by recording whether the patients needed any further admission and if this was the case, the length in days leading to their 2nd admission.

S54-02 Treating of schizophrenia in Malta

Malta is a small country in the middle of the Mediterranean. It is a member of the European Union and has a population of around 400,000. The culture is European, and around 99% of the population is Roman Catholic. There are no studies on the prevalence of schizophrenia in the Maltese population, but it is most likely that it is about 1%. During the last few years, thousands of illegal immigrants from Africa have been arriving in Malta especially during summer. It seems that the prevalence of schizophrenia in this subgroup is more than that in the local population. Studies are needed to study this phenomenon further to see if this is the case, but they are definitely being a big burden on the local psychiatric services. The National Health Service in Malta provides all treatment for schizophrenia free of charge. The pharmacological management of schizophrenia is similar to that of other European countries. Oral atypical antipsychotics are available within the National Health Services, but depot preparations are not yet available. For admissions there is a main Psychiatric Hospital, Mount Carmel Hospital, and two units in two General Hospitals. Community services are in the process of being developed. An NGO association, the Richmond Foundation also provides community and rehabilitation services. The Maltese family is still a relatively strong unit, with a lot of support in times of help being provided by the extended family. Thus in most psychosocial interventions, the family plays a central role.